Department of Gastroenterology, Infectious Diseases and Rheumatology (including Clinical Nutrition), Charité-Universitätsmedizin Berlin, Berlin, Germany.
Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany.
RMD Open. 2024 Feb 15;10(1):e004009. doi: 10.1136/rmdopen-2023-004009.
To evaluate the association of nociplastic (NoP) and neuropathic pain (NP) components with residual symptoms in patients with radiographic axial spondyloarthritis (r-axSpA) receiving biological disease-modifying antirheumatic drugs (bDMARDs).
78 patients with r-axSpA from the GErman SPondyloarthritis Inception Cohort receiving a bDMARD for at least 3 months were included in this analysis. The Widespread Pain Index (WPI) and the PainDETECT (PD) questionnaire were used to quantify the NoP and the NP components, respectively. Axial Spondyloarthritis Disease Activity Score (ASDAS) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) were used as measures of residual symptoms. C reactive protein (CRP) was used as a measure of systemic inflammatory activity. Univariable and multivariable regression analyses of disease activity were performed. The regions of the WPI score and items of the PD score were used for cluster analyses.
Linear multivariable regression analysis showed that WPI and PD were independently associated with ASDAS (b=0.1, 95% CI 0.04 to 0.17, and b=0.05, 95% CI 0.02 to 0.08, respectively) and BASDAI (b=0.24, 95% CI 0.08 to 0.39, and b=0.17, 95% CI 0.1 to 0.25, respectively) in r-axSpA patients receiving stable treatment with bDMARDs. Furthermore, WPI and PD were found to be significantly associated with the presence of relevant residual symptoms as defined by BASDAI ≥4 (OR 1.93, 95% CI 1.09 to 4.15, and OR 1.32, 95% CI 1.04 to 1.85, respectively). The effects were present also in patients with normal level of CRP. Cluster analysis revealed three distinct pain distribution profiles and four specific sensory symptom constellations allowing differentiation of different pain subtypes.
Both NoP and NP components seem to be associated with residual symptoms in patients with r-axSpA receiving treatment with bDMARDs.
评估影像学轴向脊柱关节炎（r-axSpA）患者接受生物改善病情抗风湿药物（bDMARD）治疗后，痛觉敏化（NoP）和神经病理性疼痛（NP）成分与残留症状的相关性。
本分析纳入了来自德国脊柱关节炎发病队列的 78 例接受 bDMARD 治疗至少 3 个月的 r-axSpA 患者。使用广泛疼痛指数（WPI）和疼痛 DETECT（PD）问卷分别定量 NoP 和 NP 成分。采用脊柱关节炎疾病活动评分（ASDAS）和 Bath 强直性脊柱炎疾病活动指数（BASDAI）作为残留症状的测量指标。C 反应蛋白（CRP）作为全身炎症活动的测量指标。对疾病活动度进行单变量和多变量回归分析。使用 WPI 评分区域和 PD 评分项目进行聚类分析。
线性多变量回归分析显示，WPI 和 PD 与 ASDAS（b=0.1，95%CI 0.04 至 0.17 和 b=0.05，95%CI 0.02 至 0.08）和 BASDAI（b=0.24，95%CI 0.08 至 0.39 和 b=0.17，95%CI 0.1 至 0.25）均独立相关，在接受 bDMARD 稳定治疗的 r-axSpA 患者中。此外，WPI 和 PD 与 BASDAI≥4 定义的相关残留症状的存在显著相关（OR 1.93，95%CI 1.09 至 4.15 和 OR 1.32，95%CI 1.04 至 1.85）。在 CRP 水平正常的患者中也存在这种影响。聚类分析显示，存在三种不同的疼痛分布模式和四种特定的感觉症状组合，可区分不同的疼痛亚型。
在接受 bDMARD 治疗的 r-axSpA 患者中，NoP 和 NP 成分似乎都与残留症状相关。
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